Abstract

If the World Health Organization (WHO) global maternal mortality by cause is examined for the period 1997-2007, haemorrhage constitutes 35% of deaths. Published data from the triennium 2008-2010 in South Africa indicate that if non-pregnancy-related sepsis is excluded, haemorrhage still ranks with hypertension as the most common cause of maternal deaths (24%). So how can anaesthetists improve this situation and save lives? Sadly, the main reason for the appalling figures in respect of maternal deaths in sub-Saharan Africa is poor access to basic obstetric care, blood products and basic commodities, such as electricity, for the refrigeration of blood and drugs such as oxytocin. Nevertheless, there are many areas where management, and hence outcomes, could be improved. This article addresses the crucial issues of predicting haemorrhage, assessing blood loss, point-of-care monitoring and transfusion protocols. Surgical techniques and oxytocic therapy are equally important, and are the subject of many other reviews.